kap study protocol

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KAP Study Protocol

Conducting a Knowledge, Attitude and Practice

(KAP) StudyBefore beginning the process of creating awareness in any given

community, it is first necessary to assess the environment in which awareness

creation will take place. Conducting a KAP study can best do this? KAP Study

tells us what people know about certain things, how they feel and also how they

behave. The three topics that a KAP study measures are Knowledge, Attitude

and Practice. The Knowledge possessed by a community refers to their

understanding of any given topic, diabetes and diabetic retinopathy in this case.

Attitude refers to their feelings towards this subject, as well as any preconceived

ideas that they may have towards it. Practice refers to the ways in which they

demonstrate their knowledge and attitude through their actions. Understanding

the levels of Knowledge, Attitude and Practice will allow for a more efficient

process of awareness creation as it will allow the program to be tailored more

appropriately to the needs of the community.

When assessing the KAP of a community, it is useful to divide that

community into smaller sub-categories. In this case, these categories can be

defined as the Medical Community and the General Community. The Medical

Community consists of those that are responsible for the provision of medical

care in a population, including doctors, paramedics, pharmaceutical providers,

and others. This category can be further separated into Medical Practitioners

and Paramedical Personnel in areas with a large enough population of these two

groups. The General Community consists of those who then receive that care.

There are many reasons to suspect that the levels of KAP will differ in these two


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categories, as they will have received different levels of medical training and

information in the past. It is therefore useful to tailor any awareness creation

project to suit the differences in these separate categories to attain maximum

efficiency.

STEPS IN PREPARATION OF A KAP QUESTIONAIRE

1) Domain Identification:

The domain, or subject, which the study will be conducted on, must be

identified. For the purposes of a diabetic retinopathy project, the general

domain area is diabetes and diabetic retinopathy. More specifically, the domain

will be the Knowledge, Attitude and Practices of the population in regards to

these two diseases. KAP Study Protocol

Domain identification

Endpoint of Diabetic Retinopathy Project

for Medical officers / PMP / Community

Demography .

Followup .

Importance of diabetes .

Relevance of referral .

Service .

Health Seeking behaviour .

Questionnaire Preparation

Semi-Structured interview guide (8+8)

for community

Pre-Testing

M.O / GP (13) PMP (11) Community (10+8)


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Intervention .

Service .

Counselling .

Referral .

Diabetic Management .

CME .

Analysis

Modification for Finalisation of Q

PMP - 23

K - 7

A - 8

P - 8

M.O - 24

K - 7

A - 8

P - 9

Community - 25

K - 9

A - 8

P - 8

Epidemiology .

Progress of diabetes .

Symptoms .

Diagnosis .

Treatment .KAP Study Protocol


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2) Question Preparation

Question preparation must be conducted in stages. The first stage in

preparing questions for a KAP study is to meet with diabetologists, medical

practitioners, eye-care service providers, and experts on diabetic retinopathy.

This group of specialists should then identify the Endpoints or Goals of the

awareness creation activities of the diabetic retinopathy project for Medical

Practitioners, Paramedical Personnel, and Community Members. Questions

should be created to test all three areas of the study, Knowledge, Attitude, and

Practices. KAP Study Protocol

Baseline Survey Questionnaire for Community

No:

Baseline Survey For Community

Sf-742 Diabetic Retinopathy Project

Master Questionnaire

Name: __________________________________

Type: Government/ Private Practice/ Private Hospital

Mailing Address :

Phone No:

Date:

Introduction: The Aravind Eye Hospital , has been working in the field of

eye care for the last 20 years. The main focus of its community work has

been in cataract and refraction services. Now we would like to provide

services to the community in Diabetic Retinopathy. For designing the

service we would like some information from you. This will help us to plan

and provide better service. This will take about 20 minutes of your time.


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Confidential

For research and Service purpose

Age: Sex: M/F KAP Study Protocol

Please fill up the questionnaire by writing in the response, after which

kindly handover the filled in form to the Diabetic Retinopathy team

member. You may write the response either in Tamil or English.

Consent: I am willing to provide information. My responses can be used

without any change in content.

Yes: _______________________ No: _____________________

[Please Sign]

Form checked by :____________________________

Aravind Eye Hospital

&Postgraduate Institute of Ophthalmology

74,K.K.Salai, Gandhi Nagar, Madurai 625 020

Phone: 0452-253 7580; Fax: 91-452-253 0984; Email: [email protected] KAP Study Protocol

Section-1

We are Planning to provide information on diabetes and diabetic

retinopathy for paramedical personnel. For helping us to decide the

content, please answer the following questions.

1.1. What is diabetes?

1.2. State the symptoms of Diabetes?

1.3. What are the causes of Diabetes?

1.4. Which parts of the body are mainly affected by Diabetes?

1.5. How can diabetes be identified?


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1.6. What are the treatment methods followed by diabetic retinopathy?

1.7. How does diabetes affect the eyes?

1.8. How does diabetes are at greatest risk for diabetic retinopathy?

1.9. What are the treatments given for diabetic retinopathy? KAP Study Protocol

Section 2

These are some common statements we hear in the community about

diabetes. Please read the statement and tick your opinion.

2.1Diabetes can be cured completely

1) Strongly 2) Moderately 3) Undecided 4) Moderately 5) Strongly

Agree Agree Disagree Disagree

2.2. Children can be affected if their parents are diabetic



2.3.Consuming sweets leads to diabetes



2.4.Diabetes is more among rich people



2.5.Diabetes can be cured completely by proper diet control



2.6.Diabetes are more likely develop eye problems than non-diabetics


Agree Agree Disagree Disagree KAP Study Protocol


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2.7.All diabetics should have a periodic eye examination by an

ophthalmologist one in a year.



Section 3

Currently there is not much accurate data available regarding diabetic

patients, their treatment seeking behaviour and the services available for

them. In this section we would like to know about your experience with

diabetic patients.

Diabetic patients

3.1. When and how did you came to know that you have diabetic mellitus?

3.2. For how many year/month are you a diabetic patient?

3.3.What are the treatment methods you follow to control diabetes?

3.4.Who else, besides you, are suffering from diabetic mellitus I your

family? If yes, who affected and for how long?

3.5.What treatment methods do they follow?

3.6.How many times have you undergone dilated fundus examination after

knowing that you a diabetic?

3.7.Have you shared your experienced regarding diabetes either with your

family members or friends?

3.8.Through which sources did you come to know about diabetic

retinopathy?KAP Study Protocol

3.9.What are treatments for diabetic retinopathy and where is it available?

3.10.What advices would you give to diabetic patients?

Non diabetic patients


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3.1a.Is any of your family members affected by diabetes?

3.2a.In what ways are you helping your family members, with diabetes?

3.3a.What are the advises given by you for diabetic patients?

3.4a.Do you refer diabetic patients to an ophthalmologist?

3.5a.From which source did you come to know about diabetes and diabetic

retinopathy?

3.6a.What are the information gathered from the diabetic patients after

their eye examination, which you had refered to an ophthalmologists?

3.7a.What kind of treatment method is generally followed by the people for

diabetes?

3.8a.What is the treatment for diabetic retinopathy?

Thank you very much for sparing

Your valuable time!KAP Study Protocol

Baseline Survey Questionnaire for Medical Practitioners

No:

Baseline Survey For Medical Practitioners

SF742 Diabetic Retinopathy Project


Name :

Age : Sex: M / F

Type : Government/ Private Practice/Private Hospital

Mailing

Address :

Phone No :

Date :


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Introduction: The Aravind Eye Hospital, has been working in the field of


been in Cataract and refraction services. Now we would like to provide




Please fill up the questionnaire by writing in response, after which kindly

handover the filled in form to the Diabetic Retinopathy team member. You

may write the response either in Tamil or English.

Confidential

For Research and service purpose only KAP Study Protocol

Consent: I am writing to provide information. My responses can be used


Yes: No:

[Please Sign]

Form checked by:


& Postgraduate Institute of Ophthalmology


Phone: 0452-253 7580; Fax: 91-452-253 0984; Email: [email protected] KAP Study Protocol

Section 1

We are planning to provide information on diabetes and diabetic

retinopathy for medical practitioners. For helping us to decide the content,

please answer the following questions.

1.1 Please mention all the diagnostic tests for Diabetes?


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1.2 Please mention all the symptoms of Diabetes?

1.3 Please mention the main causes for Diabetes?

1.4 Which parts of body are mainly affected by Diabetes?

1.5 List the clinical features of

a) Hyperglycemia / Ketoacidosis

b) Hypoglycemia

1.6 Which diabetic patients are at greatest risk for Diabetic Retinopathy? KAP Study Protocol

1.7 What is the treatment for a patient with Diabetic Retinopathy?

1.8 How often would you advice follow-up for Diabetic Pregnant women?

Section2



2.1) More uneducated people have diabetes than those who are educated.



2.2) All Diabetic patients must be refer to Ophthalmologists.



2.3) As long as the diabetes is kept under control, there is no need to

worry about diabetic complication.



2.4) If the doctor has told the diabetes patient to come for regular followup, the patient will come.




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2.5) If the diabetic is treated early on, diabetic retinopathy can be

prevented.


Agree Agree Disagree Disagree KAP Study Protocol

Section - 3




diabetic patients.

3.1) What type of diabetic patients are referred by you to an

ophthalmologist?

3.2) What proportion of new patients do you routinely screen for diabetes

among the patients coming to you?

3.3) How do you decide whom to refer for treatment?

3.4) When diabetic patients come to you, who else besides you provides

advice?

3.5) What advice do you give to the patient with diabetes?

3.6) How much does it take for you to explain how to manage diabetes? KAP Study Protocol

3.7) Have you taken any sessions in the past one-year to educate the public

regarding diabetes?

3.8) Do you follow-up the patients you have referred to the specialists?

3.9) From which sources have you learned about diabetic retinopathy in

the past one year?


your valuable time ! KAP Study Protocol


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Baseline Survey Questionnaire for Paramedical Personnel

No:

Baseline Survey For Paramedical Personnel

SF742 Diabetic Retinopathy Project


Name :

Age : Sex: M / F

Type : Government/ Private Practice/Private Hospital

Mailing

Address :

Phone No :

Date :

Introduction: The Aravind Eye Hospital, has been working in the field of


been in Cataract and refraction services. Now we would like to provide




Please fill up the questionnaire by writing in response, after which kindly

handover the filled in form to the Diabetic Retinopathy team member. You

may write the response either in Tamil or English.

Confidential

For Research and service purpose only KAP Study Protocol

Consent: I am writing to provide information. My responses can be used



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Yes: No:

[Please Sign]

Form checked by:


Phone: 0452-253 7580; Fax: 91-452-253 0984; Email: [email protected]


&Postgraduate Institute of OphthalmologyKAP Study Protocol

Section 1

We are planning to provide information on diabetes and diabetic

retinopathy for paramedical personnel. For helping us to decide the

content, please answer the following questions.

1.1.What is diabetes?

1.2.What are the different types of Diabetes?

1.3.State the cause for Diabetes?

1.4.Which parts of the body are mainly affected due to Diabetes?

1.5. What are the eye diseases caused by Diabetes?

1.6. Which among diabetes are at great risk for Diabetic Retinopathy?

1.7. What is the treatment for Diabetic Retinopathy? KAP Study Protocol

Section2



2.1. Consuming sweets will result in diabetes.



2.2. Diabetes are twice as likely to develop eye problem than non-diabetes.


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2.3. Persons with a fat body is more prone to diabetes



2.4. Diabetic Retinopathy due to diabetes is a common health problem



2.5. People, who follow proper diet and regular exercise, need not take

medicines for diabetes.



2.6. If the blood sugar level is kept under control, the patient need not

worry about other complication of diabetes


Agree Agree Disagree DisagreeKAP Study Protocol

2.7. Referring the diabetic patient to an ophthalmologist can prevent

diabetic retinopathy.



Section -3




diabetic patients.


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3.1. What advice will you provide when you meet the diabetic patient?

3.2. Through which source did you come to know about diabetes in the

past one year?

3.3. What advice would you give to a person who has a wound, unhealed?

3.4. Through what ways did you come to know about diabetic retinopathy?

3.5. What type of study material do you have, related to diabetes?

3.5a) Where did you get the study materials? KAP Study Protocol

3.5b) When will you use these study materials?

3.6. If a diabetic patient come to you, to whom will you refer to?

3.7. What kind of information did you come to know from the diabetic

patient you had referred?

3.8. What type of treatment method does followed by the people for

diabetes?


Your valuable time!KAP Study Protocol

Questions included in the Knowledge section should be designed to test the

knowledge of respondents on diabetes and diabetic retinopathy. These should

be open-ended questions, without multiple-choice answers provided as this can

result in guessing and therefore give a false impression of the knowledge of the

population. Questions should cover the following topics:

x Epidemiology of diabetes

x Progress of diabetes

x Symptoms of diabetes

x Diagnosis of diabetes

x Treatment options for diabetes


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x Risk factors for diabetic retinopathy

x Treatment options for diabetic retinopathy

x Service

Questions included in the Attitude section should be designed to gauge

the prevailing attitudes, beliefs and misconceptions in the population about these

diseases. This is most effectively done using a different strategy that that used

for the Knowledge section. Statements should be provided, and respondents

should be asked to indicate the extent to which they agree with those

statements, on a pre-determined scale (strongly disagree, moderately disagree,

neutral, moderately agree, strongly agree). These questions should cover the

following topics:

x Demography

x Follow-up procedure and importance

x Importance, significance, and severity of diabetes

x Importance of referral

x Health seeking behavior

Questions included in the Practice section should be designed to assess

the practices of the population with regards to these two diseases. These should

be open-ended questions like those asked in the Knowledge section, to prevent

false information as a result of guessing. These questions should cover

the following topics: KAP Study Protocol

x Intervention

x Counseling services

x Referral practices

x Diabetic management


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x Continuing Medical Education (CME)

3) Evaluation of questions

Once the questions for the study have been prepared they must be

evaluated. This evaluation should be aimed at assess their ease of

comprehension, relevance to their intended topics, effectiveness in providing

useful information, and the degree to which their meaning may vary for different

individuals, which should be kept to a minimum.

Evaluation should be conducted through a Pre-Testing of the study on a

small group of representatives from each population the study will survey. The

questionnaire should be tested on approximately 15 members of each of the

following groups: Medical Officers and General Practitioners, Paramedical

Personnel, and Community Members, including both diabetics and nondiabetics.

Once this small group has completed the questionnaire the results should

be analyzed. This analysis should evaluate the degree to which the questions

were properly understood or misunderstood, the degree to which individuals

within a group interpreted the questions differently, the effectiveness of the

questions in soliciting the proper information, and any areas of information

which were neglected by the proposed questionnaire.

Once analysis has been completed the questions should be modified to

reflect the results of the Pre-Testing. This will result in the final version of the

KAP questionnaire. KAP Study Protocol

CONDUCTING A KAP STUDY

The first step in conducting a KAP study is the selection of the sample to

which the survey will be given. The sample should be sufficiently large so as to

represent the population without being so large that the data collection and


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analysis is prohibitively difficult. In choosing a sample size be careful to take

into account that some of those selected may be difficult or impossible to

contact, or unwilling to participate in the study. A sample size of approximately

200 individuals from each group will suffice as long as care is take to ensure that

the response rate is reasonably high.

As mentioned previously, division of the population into smaller

categories is typically desirable as differing groups in the community have

different educational, cultural, and socioeconomic backgrounds and therefore

will likely have differing levels of KAP. In practice, this distinction can be made

based on geographical characteristics of the group in either Rural or Urban

settings. The characteristics of the overall population should be considered

when selecting the proportion of individuals from these categories so as to

ensure that the population sampled will reflect the population at large.

The survey should then be conducted and the data collected. A standard

method for conducting the survey should be decided upon in advance, and

should be consistent for each category surveyed so as to ensure that differences

in the result are independent of the sampling method and depend solely on the

characteristics of the population in question. Sampling methods include

interviews, either in person or on the telephone, and distribution of the

questionnaire by mail. Based on the experiences of the Lions-Aravind project, it

is not advisable to attempt to conduct a survey through mailings, as the response

rate has been observed to be significantly lower following this method than it is

using the interview method.

After collection, the data should be analyzed to determine the KAP level of

the community. Questions in the Knowledge, which often have more than one


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component to a correct answer, must be analyzed differently from those in the

Attitude section, which must in turn be analyzed differently from those in the

Practice section. For example, if asked in the Knowledge section to list the

symptoms of diabetes, a respondent may know anywhere from zero to seven

symptoms. It will likely be most useful to analyze data from this section in terms KAP Study Protocol

of the absolute number of correct responses to a question, so that it can be

determined what percentage of the population knows all of the symptoms, what

percentage knows 6, 5, and so on. The preparation of tables to illustrate both the

percentage of those knowing each individual symptom and the percentage of

people knowing multiple symptoms will provide a better understanding of the

overall knowledge of the population, as there may be some highly

knowledgeable members of each group and many others who entirely lack

knowledge, a fact that would not be apparent without a more detailed breakdown

of the data. Analysis of the responses to the Practice section should be

conducted in a similar fashion to those of the Knowledge section, and be tailored

to the specific nature of each question.

In the Attitude section, a numerical value can be assigned to each choice

in the range of responses, with the middle response given a score of zero and

positive and negative scores assigned to those around it. In this way a score can

be calculated for each individual in relation to the highest possible score.

Once the data has been collected and analyzed it should be presented in a

report that can then be distributed to other interested parties. A KAP report

should include the following items:

x Introduction As those reading the report may not be familiar with

the

problem of diabetes and diabetic retinopathy, the severity of the problem,


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the importance of KAP studies, and the characteristics of the area being

studied, all of this information should be contained in an introduction to the

report before the findings are presented.

x Design The design of the study should be explained prior to the

presentation of findings. This includes the process taken to generate the

questions that the study asks, the composition of the population being

studied, specific details about the sample used to study that population

like their geographical composition, gender and age breakdown, and the

types of institutions the work for, and any other salient features of the

study that need to be explained.

x Findings The findings of the study should be presented in a clear,

easy

to understand fashion. The results to each question should be detailed,

using graphs and tables so as to facilitate comprehension. These tables KAP Study Protocol

x should include both the raw numbers of responses for each question

and

the percentages that these numbers result in. The results of the separate

surveys for the different groups studied should be placed in separate

sections so that the data presented in the report gives an accurate

representation of the actual population studied. A short introduction to the

importance of correct Knowledge, Attitudes and Practices for each of the

groups should be given before the data collected from that group is

presented so that the reader has a clear understanding of the relevance

and importance of the results.

x Analysis The results of the study should be analyzed briefly so that

the

reader understands what the results mean. For example, merely detailing


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the responses to a question will be of little value to the reader without

additional information being provided that gives the correct response to

that question.

x Conclusion A conclusion should be drawn from the data, and

presented

in the report. For a KAP study, this conclusion should take the form of

detailing the course of action that will be taken to remedy any

unsatisfactory results of the study.

Once a report has been written, it should be edited by internal sources

and then presented to external sources as well. A review of the report for

accuracy and relevancy by at least two experts in related fields, such as

diabetologists, medical practitioners, or statisticians, will help to ensure that the

report is an accurate and useful document.

After editing is completed, the finalized report should be submitted for

publishing to all appropriate agencies. This includes any internal publishing

division, local medical journals and newsletters, and any journals, both national

and international, that may be interested in your findings. Publication in

external journals will likely require the writing of an addition, more concise

report in accordance with guidelines that these journals may have for

publication, as well as an Abstract of the report. The writing of these documents

should follow any guidelines presented by the journals, and be edited in the

same manner as the initial report.KAP Study Protocol

The knowledge gained through a KAP study can be used to shape the

form that the awareness creation process will take. Mistaken beliefs should be

righted, negative attitudes converted to favorable ones, and detrimental or

incorrect practices changed to correct ones. The KAP study will illustrate the


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areas in which the population most needs education and training. As financial

and temporal restrictions will likely exist for the program, the budget and time

frame, these areas must be evaluated and ranked in terms of their importance to

the success of the project. The actions undertaken as a result of the study

should reflect this analysis so as to guarantee that the project is as effective as

possible.

KAP studies should be conducted at regular intervals throughout the

project. Subsequent studies will not only help to ensure that the program is

evolving with the changing needs and characteristics of the environment, but

can also be used to gauge the success of the program, and its strengths and

weaknesses. These studies should be modeled on the initial one as closely as is

possible so that their findings can be compared easily and accurately, but they

should also be tailored to reflect the knowledge gained through conducting all

previous studies so that each subsequent study is more effective and efficient

that the one that preceded it.

Reports written for subsequent studies should include the same

information as the initial one did, and additional information and the awareness

creation activities undertaken during the intervening time that may have

changed the KAP of the population surveyed.

In addition to a report being written for each subsequent study,

comparisons should be made to earlier studies to help gauge the successes and

shortcomings of the project. These comparison documents should include

tables and graphs similar to the reports of each study to illustrate the change in

KAP in the population. The analysis and conclusion sections of these

comparisons should analyze the changes in KAP and therefore the effectiveness


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of the program. Once the program has been analyzed in this fashion, changes

can be made in awareness creation activities to increase its effectiveness.

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